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General NPI Number Information
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NPI Number | 1073933867
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Entity Type | Organization
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Legal Business Name | GEORGIA CLINICAL RESEARCH, LLC
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Dates
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Enumeration Date | 04/21/2014
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Last Update Date | 04/21/2014
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Provider Practice Location Address
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Address Line | 2121 FOUNTAIN DR STE A
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City | SNELLVILLE
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State | GA
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Zip | 30078-2900
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Country | US
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Telephone | 678-822-5582
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Fax | 678-822-5582
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Provider Business Mailing Address
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Address Line | 15906 FARRINGHAM DR
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City | TAMPA
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State | FL
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Zip | 33647-1108
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Country | US
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Telephone | 813-979-0945
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Fax | 813-866-7008
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. GLENDA M BURTON
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Credential | B.S.
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Telephone | 404-401-5751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1100X
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Taxonomy Name | Research Clinic/Center
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License Number |
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License Number State | FL
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